Written by AOA’s Coding and Reimbursement Committee. Excerpted from page 44 of the January/February 2022 edition of AOA Focus.
While contact lenses are a safe and effective vision correction tool for millions of Americans, appropriate physician oversight is critical.
Over the past few years, new online apps have been marketed to consumers, purporting to assess the appropriate power and fit of a contact lens without actually viewing and evaluating the contact lens on the eye of the customer. It is important that efforts be made to best understand how these changes may be impacting patient safety.
In 2014, the Centers for Disease Control and Prevention (CDC) published the report “Estimated Burden of Keratitis—United States, 2010.” The report concluded that annually there are nearly 1 million emergency room and urgent doctor visits and about $175 million is added to health care costs arising from keratitis linked to improper contact lens use. In the CDC report, it was noted that “the estimated prevalence of visits for keratitis-related diagnostic codes is likely to be an underestimate, because the datasets used in this analysis capture few visits to optometrists.” The CDC report also noted that “increased surveillance capacity is needed for microbial keratitis, in particular data from optometrist visits.”
To help with better tracking at the federal level through insurance reporting, it is essential that doctors are appropriately coding patient incidents that are directly related to contact lens problems. In 2021, an adverse event code was added for contact lens complications: Y77.11.
Y77.11 is defined as “Contact lens associated with adverse incidents; rigid gas permeable contact lens associated with adverse incidents; soft (hydrophilic) contact lens associated with adverse incidents.”
Using this adverse impact code is important to better track ocular complications that are a direct result of contact lenses. Tracking these complications will aid in combating the illegal and over-the-counter sale of contact lenses. Please be sure to append them to the claim following the appropriate diagnostic code that describes the pathology.
In addition to the Y code to report adverse events, the following is an overview of the diagnosis codes that can be used to accurately report when an eye injury is related to contact lens use:
- H18.211 Corneal edema secondary to contact lens, right eye
- H18.212 Corneal edema secondary to contact lens, left eye
- H18.213 Corneal edema secondary to contact lens, bilateral
- H18.821 Corneal disorder due to contact lens, right eye
- H18.822 Corneal disorder due to contact lens, left eye
- H18.823 Corneal disorder due to contact lens, bilateral
- H16.00 (1,2,3,9) Unspecified corneal ulcer
- H16.04 (1,2,3,9) Marginal corneal ulcer
- H16.40 (1,2,3,9) Unspecified corneal neovascularization
Additionally, keratitis should be reported with the H16 code series on the same claim line.
- H16.10 Unspecified superficial keratitis
H16.101 ...... right eye
H16.102 ...... left eye
H16.103 ...... bilateral
- H16.11 Macular keratitis
H16.111 ...... right eye
H16.112 ...... left eye
H16.113 ...... bilateral
- H16.12 Filamentary keratitis
H16.121 ...... right eye
H16.122 ...... left eye
H16.123 ...... bilateral
- H16.14 Punctate keratitis
H16.141 ...... right eye
H16.142 ...... left eye
H16.143 ...... bilateral
- H16.32 Diffuse interstitial keratitis
H16.321 ....... right eye
H16.322 ........ left eye
H16.323 ........ bilateral
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